Doctors urged to be more mindful of costs of procedures they order

Lack of transparency on prices, desire not to factor money in determining medical care work against patients

August 29, 2012|By Lisa Pevtzow, Special to the Tribune

(James C. Svehla, Chicago Tribune)

What if your hotel bill looked like a hospital bill, asks Vineet Arora, an assistant dean and associate professor of medicine at University of Chicago's Pritzker School of Medicine?

What if every guest received a different rate card, unneeded services were ordered and you were hit at the end with a huge bill that no one could explain?

"No one would ever go to a hotel like that," Arora said.

Yet every day, many patients enter the hospital without any idea how much their bill will be, and many doctors order tests and perform procedures oblivious to their cost.

Arora is part of small but growing movement of doctors and medical students who are trying to add "do no financial harm" to the Hippocratic oath taken by doctors and other medical personnel. She is creating a series of training videos for medical schools to help make students mindful not only of the cost to society of the care they will order but also of the cost to the patient.

"Our sector is eating into people's pocketbooks," said Andrew Levy, a recent medical school graduate who is working with Arora on the curriculum.

According to a 2005 Harvard study, medical bills are the No. 1 cause of bankruptcy in the U.S. Yet, of the $2.6 trillion spent each year on health costs, about 30 percent of that is not actually helping patients, and in some cases hurts them, said Steven Weinberger, CEO and executive vice president of the American College of Physicians. Doctors are responsible for a lot of that cost, which can be reduced without jeopardizing care, he said.

"We feel that it is our responsibility as physicians to be addressing this, because we have control over this. Not just the direct costs but also the finding of minor abnormalities that lead to a snowball effect, he said.

There is no other industry where the price for the exact same thing varies so widely, said Jeffrey Rice, CEO of Healthcare Blue Book, which compiles medical price data. For a patient paying out of pocket, a colonoscopy can cost from just under $1,000 to about $3,500, depending on the facility. If you add in the fact that each insurance company maintains dozens of different plans, the system is opaque to doctors as well as patients, he said.

"The lack of transparency about prices within the medical system is staggering," Weinberger said. "There is a cloud of secrecy over the whole system, and the patients who can least afford it often get the highest bills."

Levy said that if an uninsured or underinsured patient asks him what a medical bill would be, it's a question he does not know how to answer.

"We are totally insulated from price, what medical care actually costs the patient," he said. "I can't tell when a test I order becomes a bill or if and when my patient gets charged by it, and that's absurd."

Before Levy went to medical school, he suffered a torn cartilage in his knee. His doctor, he said, ordered an MRI, which would have cost Levy between $700 and $2,500 depending on the facility, since he had a $3,000 deductible on his health insurance. But he found out that he really didn't need the test after all, he said.

"This was nuts," Levy said, "to pay $700 out of my pocket for a test I didn't need. And I keep this in mind, that this is what my patients are going through."

Levy said the opacity of the system that insulates doctors from the cost side is not bad just for patients but for the medical field as a whole.

"We're in a service industry, one of the least consumer friendly," he said. "It sucks being in an industry where we can't help patients better."

Most doctors have little or no idea of how their decisions impact what people actually pay, and because of the complexity of system they have a hard time finding out, said Neel Shah, executive director of the not-for-profit Costs of Care and chief medical resident at Brigham & Women's Hospital in Boston.

Shah's organization, which commissioned Arora to create the medical school curriculum with a grant from the American Board of Internal Medicine, seeks to make the medical system more transparent. A major effort of the organization is to help doctors, who are often uncomfortable talking about money and the business side of medicine in general, understand their effect on the patient's wallet. He says the way the system works right now, to use a different metaphor, is like a restaurant menu with no prices, and people who order off of a menu with no prices always order steak.

"Not only are doctors not taught what things cost, but they traditionally have been taught not to think of it, as if thinking about costs somehow detracts from thinking about doing everything possible for the patient," Shah said.

"We were trained to be medical Sherlock Holmeses," said June McKoy, ageriatric specialistat Northwestern Memorial Hospital and an associate professor of medicine at Northwestern University's Feinberg School of Medicine.